Assuntos
Fístula Biliar/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Infecções por Escherichia coli/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Abscesso Hepático/microbiologia , Idoso , Fístula Biliar/cirurgia , Doenças do Colo/cirurgia , Diagnóstico Diferencial , Infecções por Escherichia coli/cirurgia , Humanos , Fístula Intestinal/cirurgia , Abscesso Hepático/cirurgia , Masculino , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Cholecystocolonic fistula (CCF) is the second most common cholecystoenteric fistula and is often discovered intraoperatively, resulting in a challenging situation for the surgeon, who is forced to switch to a complex procedure, often in old, unfit patients. Management of this uncommon but possible finding is still ill defined. METHODS: An extensive review of 160 articles published from 1950 to 2006 concerning 231 cases of CCF was performed. RESULTS: CCF is mostly an affliction of women in their sixth to seventh decades and is rarely diagnosed preoperatively. Chronic diarrhea is the key symptom in nonemergency patients, but, in one-fourth of cases, CCF presents with an acute onset, mostly biliary ileus. In one-fourth of patients, a second hepatobiliary abnormality is present, including gallbladder cancer in 2% of cases. In uncomplicated cases, diverting colostomy is not performed anymore, and laparoscopy treatment has been described in specialized centers. Symptomatic treatment of concomitant biliary ileus (without treating CCF) is a feasible option. Resolution of colonic biliary ileus by interventional endoscopy is reported. CONCLUSION: CCF should be considered in differential diagnosis of diarrhea, especially in old, female patients. A possible second hepatobiliary abnormality should be always investigated. Extemporaneous frozen section should be performed if gallbladder cancer is suspected. Depending on clinical presentation, different treatments for CCF are indicated, ranging from minimally invasive procedures to extensive resection.
Assuntos
Fístula Biliar/complicações , Doenças do Colo/complicações , Fístula Intestinal/complicações , Fístula Biliar/diagnóstico , Fístula Biliar/epidemiologia , Fístula Biliar/cirurgia , Doenças do Colo/diagnóstico , Doenças do Colo/epidemiologia , Doenças do Colo/cirurgia , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/epidemiologia , Fístula Intestinal/cirurgiaRESUMO
Splenic rupture is a rare and severe complication of laparoscopic surgery. We report a case of delayed splenic rupture as a severe complication of laparoscopy, occurring 5 days after surgery performed on a 52-year-old woman with history of abdominal surgery and with acute pelvic infection. Subcapsular hematoma, resulting in splenic rupture, may have been a result of overlooked puncture by the Veress needle or by tension on splenic adhesions during lysis. The diagnosis should be brought up during postoperative care in case of severe pain with hemodynamic failure, hemoglobin concentration decrease, or both.